ArticleNorth American Spine Society journal2025
Sacroiliac joint fusion: incidence, timing, and risk factors for contralateral fusion.
Article in North American Spine Society journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Minimally invasive sacroiliac joint fusion evidence gaps with biomechanics, devices, and industry influence: A narrative review.Brain & spine · 2026Review
- Age and fixation strategy as associated factors for sacroiliac joint dysfunction after posterior pelvic ring fixation.Frontiers in surgery · 2025Article
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7 authors.
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Abstract
Background: Sacroiliac joint (SIJ) dysfunction is implicated in 15% to 25% of cases of chronic lower back pain, a leading cause of disability globally. Sacroiliac joint fusion (SIJF) has become an increasingly utilized treatment for refractory SIJ pain, with its adoption projected to rise significantly. While SIJF can alleviate symptoms, many patients develop contralateral SIJ pathology requiring subsequent surgery. Understanding the incidence, timing, and risk factors for bilateral SIJF is critical for improving patient outcomes, managing expectation, and guiding surgical decision-making.This study aimed to (1) determine the incidence of bilateral SIJF, (2) assess the timing between initial ipsilateral and subsequent contralateral SIJF, (3) identify risk factors associated with progression to contralateral SIJF, and (4) compare the timing to contralateral SIJF between patients presenting with unilateral versus bilateral SIJ dysfunction. Methods: A retrospective review was conducted identifying 323 consecutive SIJFs performed between 2011 and 2024 at an integrated healthcare system. Three clinical cohorts were identified based on progression to SIJF. Cohort 1 included patients who underwent unilateral SIJF only. Cohort 2 patients developed contralateral SIJ pain following initial SIJF, while Cohort 3 patients had bilateral SIJ pain prior to initial SIJF. Demographics and prior spine surgical details were collected and included in multivariate analysis. Kaplan-Meier survival curves were used to evaluate the timing between SIJFs. Comparisons between groups were established with student's Results: A total of 57 (21%) patients underwent bilateral SIJF. Prior L5-S1 fusion was associated with a higher likelihood of bilateral surgery (OR = 2.55, p = .042), while prior lumbar fusion not involving L5-S1 was protective (OR = 0.20, p = .036). Over 90% of contralateral SIJF cases occurred within 18 months of the initial ipsilateral SIJF procedure. Patients in Cohort 3 progressed more rapidly to contralateral surgery than those in Cohort 2 (6.2 months vs. 12.7 months, p = .004). Average body mass index (BMI) was higher in Cohort 3 patients (31.9 kg/m Conclusions: Contralateral SIJF occurs in 21% of patients who have undergone initial unilateral SIJF, with over 90% of cases occurring within 18 months of the initial ipsilateral fusion procedure. Bilateral SIJ pain prior to initial SIJF and prior L5-S1 fusion are key predictors of contralateral surgery. Patients with bilateral SIJ pain had elevated BMI. These findings highlight the importance of early identification of high-risk patients to inform treatment decisions and potentially improve outcomes.
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